KHOPOTSO: It would seem that even in South Africa the debate is leaning heavily towards making the HIV test a routine practice in public health. Jonathan Berger, a researcher at the AIDS Law Project, is one of those in support of routine testing for HIV. But, he cautions that certain pre-conditions must be adhered to.
JONATHAN BERGER: The routine offer of HIV testing should be introduced in South Africa as long as it is not introduced in a way that dispenses with the need for pre and post-test counselling and proper informed consent. It not only makes good public health sense. It’s also a constitutional requirement.
KHOPOTSO: Supreme Court of Appeal Judge, Mr Justice Edwin Cameron ‘ who himself lives openly with HIV ‘ also welcomes the notion of making testing for HIV a routine exercise. But he, too, believes that certain principles, which guarantee the respect of the individual, must guide such a policy.
EDWIN CAMERON: I’m scared of talking about routine HIV testing without specifying the pre-conditions. We’ve got to have an environment where treatment is being offered as a real option to the patient; we’ve got to have an environment where confidentiality is respected. Confidentiality is different from disclosure. Disclosure is the choice of the patient. And we’ve got to have an environment where our legal and constitutional guarantees of non-discrimination, which the Constitutional Court so boldly reinforced in the Hoffman vs SAA decision, where those are realities that people feel safe-guard them in their lives. Once we have those three pre-conditions I’ve mentioned, then we can move to a position where HIV testing becomes routine.
KHOPOTSO: But should testing for HIV be made routine in South Africa? Or could we run the risk of conflict between human rights’ principles and good public health practices? Jonathan Berger of the AIDS Law Project is well aware of the debate.
JONATHAN BERGER: There are ways of respecting people’s human rights and giving effect to them in a way which makes good public health sense. I have not yet heard any convincing argument, which explains why violating someone’s right to privacy or confidentiality makes good public health sense. I have yet to hear a convincing argument. The arguments are often made along the lines that pre-suppose that the right to privacy, the right to confidentiality, precludes a doctor or another health care worker, from offering testing. And that in my view is an incorrect understanding of the right. I think one of the crucial points is that there is no disconnect between good public health and human rights. The two support each other and feed into each other.
KHOPOTSO: Perception of risk is a highly personal issue and relatively small numbers of South Africans have come forward voluntarily to test and find out their status. A recent survey by Wits University’s Reproductive Health Research Unit and loveLife, shows that among the youth who tested positive in 2003, 60% did not believe that they were at risk of infection. Now, to what extent can routine testing improve attitudes towards testing for HIV? Here’s Edwin Cameron.
EDWIN CAMERON: It’s a process involving a lot of vicious circles that we’ve got to turn into beneficence circles, if we possibly can. At the moment the stigma is so great that people don’t want to be tested; and because they don’t want to be tested they don’t know their HIV status; because they don’t know their HIV status, they’re not talking about it to anyone’¦ Once we break down the stigma ‘ not just about AIDS and HIV ‘ but the stigma about being tested, we can get a greater circle of people who’re talking about their own HIV status. So, the beneficence circle will be the more people who say ‘yes, I was tested; yes, I’m HIV positive; yes, I have chosen to go on to treatment,’ the more other people will follow their example.
KHOPOTSO: Jonathan Berger of the AIDS Law Project.
JONATHAN BERGER: I think if properly implemented the routine offer of testing can go a long way to de-stigmatising HIV and AIDS. I think if it is offered at every opportunity in the health care system, regardless of someone’s health status, that could be a really positive development. But if it’s done in a way that the test is only done when someone comes in presenting with symptoms of AIDS, then that has the potential to further stigmatise HIV and AIDS’¦ We need to find ways of routinely offering HIV testing both within and outside of the health care system.
KHOPOTSO: After more than a week of trying to get the national Department of Health’s views on the matter of routine testing for HIV, the department has failed to comment. Meanwhile, the subject is so topical that Health-e has learnt that the Nelson Mandela School of Medicine is planning a research project on the cost-effectiveness of the policy compared to the current VCT service.
E-mail Khopotso Bodibe
